Chronic Pelvic Pain Syndrome

Men who experience pelvic pain may be more common than you think.  It is estimated that 8-16% of men in America will suffer with chronic pelvic pain syndrome (CPPS) at some point in their lives.  The dilemma is that too often male pelvic pain is thought to be caused by prostatitis and many men are prescribed medication in the absence of a true infection.  In fact, the majority of young men diagnosed with prostatitis do not have a prostate infection and instead have pelvic floor dysfunction.

What are some of the common symptoms of CPPS? 

- Pain in the low back, abdomen, and pelvic area including groin, penis, perineum, scrotum/testicles, or rectum

- Pain with prolonged sitting, tight clothing, or certain exercises such as squatting or cycling 

- Dysuria (pain or burning with urination) 

- Urinary urgency and/or frequency 

- Urinary hesitancy (difficulty starting stream of urine) 

- Stop and go urination 

- Feeling of incomplete urination 

- Nocturia (nighttime urination) 

- Pain or burning during or after ejaculation

- Premature ejaculation 

- Erectile dysfunction (weaker erectile strength, difficulty or pain gaining and/or maintaining an erection) 

- Decreased libido 

What can cause CPPS? 

Sometimes it’s the perfect storm that causes CPPS.  The most common causes are: 

- Pelvic floor muscle dysfunction

- Excessive sitting

- Surgical trauma (vasectomy, prostatectomy, hernia repairs)

- Orthopedic/sports injuries 

- Biomechanical dysfunction 

- Excessive exercise or change in routine 

- Chronic constipation or staining with bowel movements 

- Chronic infections, including bacterial prostatitis or STD 

- Stress 

What are the treatment options for CPPS? 

Treatment of CPPS is often multimodal.  It is best to contact your urologist first to rule out any pathology or infection within the prostate.  If you get the all clear and pathology is ruled out, it’s time to make a call to a pelvic floor physical therapist  for an evaluation.  

Pelvic floor physical therapists are able to offer a range of treatment techniques that are safe and effective for CPPS. Some of the treatment techniques may include:

- Myofasical trigger point release and soft tissue mobilization, which can include internal and external treatment of pelvic floor muscles, abdominal wall, and lumbar musculature.

- Visceral mobilization to address the fascial system and connective tissue 

- Neuromuscular re-education to improve dynamic pelvic stability and force transfer with activity 

- Postural re-education 

- Therapeutic Exercise to improve range of motion, flexibility, and strengthen weak muscles 

- Biofeedback to facilitate lengthening and/or strengthening of pelvic floor musculature 

- Diaphragmatic breathing with focus of pelvic floor lengthening  

- Bowel and bladder recommendations 

Pelvic pain and sexual dysfunction of any kind is not normal and should not be ignored.  Once infection is ruled out by your medical provider, a pelvic floor PT can help identify and conservatively address the cause of your pelvic pain.  As always, you can find a pelvic floor therapist near you on www.pelvicrehab.com or reach out with any questions!